Efficacy of esketamine in alleviating emergence delirium and agitation in pediatric patients undergoing adenotonsillectomy under general anesthesia.

OBJECTIVE

To analyze the effect of esketamine on emergence delirium (ED) and emergence agitation (EA) in pediatric patients under general anesthesia.

METHODS

This retrospective study included 94 pediatric patients who underwent adenotonsillectomy under general anesthesia at General Hospital of Ningxia Medical University from January 2023 to October 2024. The patients were divided into three groups according to different anesthesia protocols they received: Group A (n=30, esketamine 0.5 mg/kg), Group B (n=32, esketamine 0.75 mg/kg), and Group C (n=32, fentanyl 2 µg/kg). Hemodynamic values, surgical indicators, pstoperative pain and agitation (the Face, Legs, Activity, Cry, and Consolability (FLACC) scale face, legs, activity, Cry, and consolability (FLACC) scale and the Pediatric Anesthesia Emergence Delirium (PAED) scale), the incidence of EA and ED, and perioperative adverse events were compared across the groups. Factors associated with EA and ED occurrence were analyzed.

RESULTS

Groups A and B exhibited significantly shorter time to spontaneous respiration, extubation, and awakening than Group C (<0.05). Perioperative heart rate and mean arterial pressure were more stable in Groups A and B (<0.05). No significant intergroup differences were observed in post-extubation FLACC scores among the groups (>0.05). However, Group B demonstrated significantly lower PAED scores than both Groups A and C (<0.05). The incidence of EA and ED was highest in Group C (28.13% and 21.88%, respectively; <0.05). Group C had higher rates of nausea, vomiting, and excessive airway secretions (<0.05). Esketamine administration at 0.75 mg/kg significantly reduced the risk of EA (=0.039) and ED (=0.043).

CONCLUSION

Compared to fentanyl, esketamine, particularly at a dose of 0.75 mg/kg, eenhanced perioperative hemodynamic stability, reduced postoperative ED and EA incidence, and demonstrated a favorable safety profile in pediatric adenotonsillectomy.